Provider Demographics
NPI:1568164762
Name:ROGGIN, JEFFREY HY (DPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HY
Last Name:ROGGIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:ROGGIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3419 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3377
Mailing Address - Country:US
Mailing Address - Phone:310-432-3368
Mailing Address - Fax:
Practice Address - Street 1:11825 MAJOR ST STE 107
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6356
Practice Address - Country:US
Practice Address - Phone:310-915-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist